Chinese Journal of Blood Purification

12 November 2025, Volume 24 Issue 11 Previous Issue    Next Issue

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Body Composition and Mass Management in Dialysis Patients YANG Li-jiao, WU Yong-kang, ZHANGDong-liang 2025, 24 (11):  881-884.  doi: 10.3969/j.issn.1671-4091.2025.11.001 Abstract ( 121 )   Dialysis is a crucial treatment for maintaining the lives of patients with End-Stage Kidney Disease (ESKD), and dry weight (DW) management is one of the key components of dialysis therapy. An inappropriate DW setting may lead to volume overload or volume depletion, which significantly increases the risk of complications in dialysis patients, particularly cardiovascular events and mortality. In addition, dialysis patients face a range of complex health challenges, including muscle atrophy, osteoporosis, obesity, and malnutrition. These factors collectively affect their "body composition," which refers to the proportion and functional status of lean tissue (such as muscles and bones) relative to adipose tissue. This review aims to explore recent advances in the management of "body composition" in dialysis patients, covering assessment methods, management strategies, and the role of adjunctive therapies in improving patient outcomes. Metrics

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The present situation and progress of bodyweight and volume management in peritoneal dialysis patients XU Xiao-yi 2025, 24 (11):  885-888.  doi: 10.3969/j.issn.1671-4091.2025.11.002 Abstract ( 102 )   The bodyweight management (including nutritional and obesity status) and dry weight assessment (fluid balance) of patients undergoing peritoneal dialysis (PD) are key factors affecting their clinical prognosis. In recent years, progress has been made in weight management for PD patients with the development of nutritional intervention strategies, volume assessment methods, and personalized dialysis prescription. However, many challenges remain unresolved. Based on recent literature and summarizes, this article summarized the current status and progress of weight and volume management in PD patients, covering aspects such as diet management, physical exercise, medication treatment, dialysis prescription adjustment, and future prospects. Metrics

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Summary of the best evidence for dry weight management in maintenance hemodialysis patients XIAO Jia-yi, SUN Bei-di, GAO Kang, LIU Ying-hong 2025, 24 (11):  889-894.  doi: 10.3969/j.issn.1671-4091.2025.11.003 Abstract ( 125 )   Objective  To retrieve, extract, evaluate, and integrate evidence on dry weight management in maintenance hemodialysis (MHD) patients to provide an evidence-based basis for healthcare professionals to develop a dry weight management program for MHD patients.  Methods  To search for evidence related to the management of dry body quality in MHD patients in domestic and international websites, guideline repositories, and databases according to the “6S” evidence pyramid model, including guidelines, expert consensus, evidence summaries, clinical decision-making, systematic evaluations, meta-analyses, and original studies. The timeframe for the search was January 1, 2020 to January 1, 2025.  Results  A total of 16 articles were ultimately included in the literature, comprising 5 guidelines, 4 systematic evaluations, 1 evidence summary, 5 randomized controlled trials, and 1 cohort study. A total of 27 pieces of evidence were summarized in 6 dimensions: dry weight assessment and optimization, sodium restriction and behavioral interventions, scientific management of dry weight, frequency and duration of dialysis, personalized adjustment of dialysis solution, and dialysis temperature and duration.   Conclusion  This study provides the best evidence for the management of dry body quality in MHD patients and serves as a reference for evidence-based clinical practice by healthcare professionals. Metrics

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Relationship between percentage of interdialysis weight gain and cardiovascular function in maintenance hemodialysis patients GUO Xue-na, GAO Yan , LI Xue-mei, REN Jian-wei 2025, 24 (11):  895-898.  doi: 10.3969/j.issn.1671-4091.2025.11.004 Abstract ( 92 )   bjective  To investigate the relationship between the percentage of interdialysis weight gain (PIWG) and cardiovascular function in maintenance hemodialysis (MHD) patients.  Methods  A retrospective analysis was conducted on patients receiving MHD at the Hemodialysis Center of Aviation General Hospital between September and November 2024. Based on PIWG, patients were divided into a low PIWG group (PIWG＜5%,  n=64) and a high PIWG group (PIWG≥5%, n=36). Intergroup comparisons and multivariate correlation analyses were conducted for statistical evaluation of demographic data, biochemical parameters, blood pressure, and echocardiographic parameters between the two groups.   Results   A total of 100 patients were enrolled, including 64 in the low PIWG group and 36 in the high PIWG group. The high PIWG group exhibited higher pre-dialysis systolic blood pressure (t =-3.380, P =0.001), pre-dialysis pulse pressure (t =-2.276, P = 0.025), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (Z =-3.160, P =0.002), left atrial anteroposterior diameter (t =-3.573, P=0.001), left atrial volume index (t =-3.380, P =0.001), interventricular septal thickness (Z=-2.410, P=0.016), and E/e’ ratio (t =-3.003, P =0.003) , but lower left ventricular ejection fraction (Z=2.246, P=0.025) compared to the low PIWG group. Correlation analysis revealed that PIWG was positively associated with NT-proBNP (r=0.395, P=0.001), pre-dialysis systolic blood pressure (r=0.423, P= 0.001), pre-dialysis pulse pressure (r=0.277, P=0.005), left atrial volume index (r=0.211, P=0.035), interventricular septal thickness (r=0.201, P=0.045), and E/e’ ratio (r=0.224, P=0.025).  Conclusion  PIWG is closely associated with cardiovascular function in MHD patients, influencing systolic blood pressure, pulse pressure, and cardiac structural/functional parameters. Metrics

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Predictive value of body mass index combined with normalized protein catabolic rate for volume status identification in peritoneal dialysis patients ZHAGN Man, SUO Jin-ya, CHEN Yun -min, XU Xiao-hui, Yu Le, YU Yu-sheng, ZHOU Ting-ting 2025, 24 (11):  899-903.  doi: 10.3969/j.issn.1671-4091.2025.11.005 Abstract ( 57 )   Objective To investigate the predictive value of body mass index (BMI) combined with normalizing protein catabolic rate (nPCR) for identifying volume status in peritoneal dialysis (PD) patients.  Methods  This is a single-center retrospective study, patients who underwent maintenance PD treatment at the Jinling Hosptial, Nanjing University School of Medicine from March 2004 to March 2024 were included. Based on the cardiothoracic ratio (CTR), the patients were divided into normal volume group (CTR＜0.5) and volume overload group (CTR≥0.5). Relevant data were collected, and univariate analysis and binary Logistic regression analysis were used to screen the influencing factors of volume overload in PD patients. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of BMI combined with nPCR for volume overload.  Results  A total of 2109 patients were included, including 1002 patients in the normal volume group and 1107 patients in the volume overload group. Multivariate binary logistic regression analysis showed that  nPCR (OR=0.022, 95% CI:0.011～0.046, P＜0.001), total creatinine clearance (OR= 0.988,  95% CI: 0.980～0.996, P=0.004), serum albumin (OR=0.944, 95% CI: 0.915～0.974, P＜0.001), dialysis vintage (OR=1.004, 95% CI:1.000～1.008, P=0.028), hemoglobin (OR=0.888, 95% CI:0.834～0.946, P＜ 0.001), BMI (OR=1.290, 95% CI: 1.230～1.354, P＜0.001), and urine output (OR=0.999, 95% CI: 0.999～1.000, P ＜ 0.001) were independent risk factors for volume overload in PD patients. The area under the ROC curve (AUC) showed that nPCR (AUC=0.749, 95% CI: 0.686～0.730), BMI (AUC=0.702, 95% CI: 0.680～0.724), and the combination of BMI and nPCR (AUC 0.759, 95% CI: 0.739～0.780) had statistically significant predictive value for volume overload in PD patients (P＜0.001).  Conclusion  The combination of BMI and nPCR is a good predictor of volume overload in PD patients. Metrics

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Effect of resistance exercise on bone mineral density in maintenance hemodialysis patients HU Xiao-hua, HAO Xiao-ping, LIU Jin-jin, WANG Li, HE Yun-lan, WU Bi-bo 2025, 24 (11):  904-908.  doi: 10.3969/j.issn.1671-4091.2025.11.006 Abstract ( 70 )   Objective  To investigate the effect of resistance exercise on bone mineral density (BMD) in maintenance hemodialysis (MHD) patients by implementing lower limb resistance exercise rehabilitation training. Methods  MHD patients on regular dialysis at Shanghai Jing 'an District Zhabei Central Hospital from October 2022 to November 2023 were selected as the study subjects. Patients were randomly divided into either an exercise rehabilitation group or a control group. The control group received routine treatment, while the exercise rehabilitation group received additional intra-dialytic lower limb resistance exercise training based on routine treatment. The follow-up period was 6 months. Changes in BMD, skeletal muscle index (SMI), calcium, phosphorus, parathyroid hormone, osteocalcin (OC), N-terminal propeptide of type I procollagen (PINP), and beta C-terminal telopeptide of type I collagen (β-CTX) were compared between the two groups.  Results  A total of 90 patients were enrolled, with 45 patients in each group. Before the study, there were no statistically significant differences in SMI and BMD between the two groups (t=0.759, P=0.450; t=0.003, P=0.997). After 6 months of treatment, both SMI [(7.73 ± 1.01) kg/m²] and BMD [(0.470 ± 0.089) g/cm²] in the exercise rehabilitation group increased compared to pre-study levels [SMI(7.03±1.20)kg/m2, BMD (0.419±0.098)g/cm2], and the comparative differences were statistically significant (t=-2.615, P=0.002; t=-0.867, P=0.012). Compared to the control group during the same period (SMI 7.19±1.13 kg/m2, BMD 0.418±0.098 g/cm2)，the differences were also statistically significant (t=-2.390, P=0.019, t=-2.598, P=0.011). Before the study, there were no statistically significant differences in OC, β-CTX, and PINP between the two groups (Z=-0.105, P=0.292; Z=-1.126, P=0.260; Z=-0.195, P=0.846). After 6 months of treatment, the differences in OC, β-CTX, and PINP between the exercise rehabilitation group and the control group were statistically significant (Z=-3.531, P＜0.001; Z=-2.841, P=0.005; Z=-3.635, P＜0.001).  Conclusion   A 6-month lower limb resistance exercise rehabilitation program for MHD patients is safe and effective, improving muscle mass, increasing bone mineral density, and reducing the risk of osteoporosis. Metrics

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A survey based on society ecosystems theory: status and influencing factors of successful aging in elderly patients undergoing maintenance hemodialysis GAO Xin-ru, JIANG Rui, ZANG Li-li, LUO Ming-jun, HONG Cheng-bo 2025, 24 (11):  909-913.  doi: 10.3969/j.issn.1671-4091.2025.11.007 Abstract ( 59 )   Objective  To investigate the status and influencing factors of successful aging (SA) in elderly maintenance hemodialysis (MHD) patients based on society ecosystems theory.   Methods  A cross-sectional survey was conducted by convenience sampling on 325 elderly MHD patients from February to June 2024.  Results  The SA score of elderly MHD patients was (38.54 ± 10.90) points. Multiple linear regression analysis showed that in the microsystem, education level (junior high school: β=0.107, P=0.001; high school/technical secondary school: β=0.124, P＜0.001; college or above: β=0.150, P＜0.001), monthly household income per capita (1000～3000 yuan: β=0.217, P＜0.001; 3000～5000 yuan: β=0.423, P＜0.001; >5000 yuan: β=0.461, P＜0.001), marital status (β=-0.117, P＜0.001), exercise habit (occasional: β=0.080, P=0.008; regular: β=0.118, P=0.001), and sense of meaning in life (β=0.379, P＜0.001) were influencing factors for SA in elderly MHD patients. In the mesosystem, perceived social support (β=0.086, P=0.004), particularly family support, was an influencing factor for SA in elderly MHD patients.  Conclusion  The SA level of elderly MHD patients is relatively low. Clinical healthcare providers are advised to focus on patients who are divorced/widowed, have low education levels, low income, low social support, low sense of meaning in life, and poor exercise habits, and to adopt active nursing measures to help improve their SA level. Metrics

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Effects of different blood purification modalities on serum β2-microglobulin, lipid profile, and vascular calcification LI Zhi-quan, LIANG Juan, WU Xin 2025, 24 (11):  914-918.  doi: 10.3969/j.issn.1671-4091.2025.11.008 Abstract ( 69 )   Objective To investigate the impact of different blood purification modalities on serum β2-microglobulin (β2-MG) level, lipid profile, and vascular calcification in patients undergoing maintenance hemodialysis (MHD).  Method  A retrospective analysis was conducted on clinical data of the 174 patients admitted to Puyang People’s Hospital between January 2019 and December 2022 for MHD. According to the blood purification modality they used, the patients were divided into three groups: conventional hemodialysis (HD) group (n=58), hemodialysis combined with hemodiafiltration (HD+HDF) group (n=58), and hemodialysis plus hemodiafiltration and hemoperfusion (HD+HDF+HP) group (n=58). Serum β2-microglobulin, lipid profile, and the extent of vascular calcification were compared among the three groups. Logistic regression was employed to identify risk factors for vascular calcification.  Result  After dialysis, blood phosphorus, intact parathyroid hormone (iPTH), β2-MG, total cholesterol (TC), triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) in HD group were higher than those in HD+HDF group and HD+HDF+HP group (F/χ²=12.753, 12.552, 6.524, 5.873, 10.908 and 17.272 respectively; P＜0.001), while high-density lipoprotein cholesterol (HDL-C) in HD group was lower than that in HD+HDF group and HD+HDF+HP group (F=17.148，P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG and LDL-C in HG group were higher than those in HD+HDF group (t=12.963, 13.630, 5.648, 5.242, 11.044 and 18.632 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF group (t=17.031, P＜0.001). Blood phosphorus iPTH, β2-MG, TC, TG, LDL-C in HG group were higher than those in HD+HDF+HP group (t=13.921, 14.567, 6.853, 6.320, 9.282 and 16.041 respectively; P＜0.001), while HDL-C in HD group was lower than that in HD+HDF+HP group (t=18.242, P＜0.001). Vascular calcification rate in HD group was higher than that in HD+HDF+HP group (t=5.570, P＜0.001). Age, dialysis age, blood calcium, blood phosphorus, iPTH, TC, LDL-C, and β2-MG in vascular calcification group were higher than those in non-calcification group (t=8.630, 6.205, 6.073, 4.598, 4.617, 3.562, 4.648 and 5.673 respectively; P＜0.001). Logistic regression showed that age, dialysis age, blood calcium, blood phosphorus, iPTH, and β2-MG were the independent risk factors for vascular calcification (OR=1.123, 1.087, 4.582, 3.874, 2.034 and 2.402 respectively; 95% CI:1.034～1.346, 0.012～1.298, 452～15.224, 1.376～13.302, 1.173～8.375 and 1.256～11.408 respectively; P=0.004,＜0.001,          ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively).   Conclusion   The occurrence of vascular calcification in MHD patients is related to multiple factors. Clinical monitoring and timely intervention are needed to reduce the risk of vascular calcification. Metrics

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Construction of a column chart prediction model for individualized prediction of constipation risk in maintenance hemodialysis patients ZHAO Ying-ying, ZHONG Li-li, GAO Xue-ping, WANG Qi, Yang Jing, GU Hong-ye 2025, 24 (11):  919-923,928.  doi: 10.3969/j.issn.1671-4091.2025.11.009 Abstract ( 83 )   Objective  To explore the influencing factors of constipation in maintenance hemodialysis (MHD) patients and to construct a column chart prediction model.  Methods  A total of 135 patients who underwent MHD in Huai’an Second People's Hospital from April 2021 to June 2023 were regarded as the modeling group. A total of 58 MHD patients from July 2023 to November 2024 were recruited as the validation group. According to the occurrence of constipation during MHD, the modeling group was assigned into constipation group (n=56) and non-constipation group (n=79). The influencing factors of constipation in the MHD patients were analyzed using multivariate logistic regression. A column chart prediction model for constipation risk in MHD patients was then constructed using the R software. Predictive performance of the model was evaluated through receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and calibration curve.  Results Among the 193 MHD patients, a total of 78 cases experienced constipation, with an incidence rate of 40.41%. Compared with the non-constipation group, the constipation group had higher rates of diabetes nephropathy, dialysis age≥5 years, and lying in bed in most daytime (c2=5.539, 5.053 and 4.293; P=0.019, 0.025 and 0.038), while plasma albumin was lower (t=4.161, P＜0.001). Multivariate logistic regression found that diabetes nephropathy (OR=5.739, 95% CI: 2.089～15.767, P=0.001), dialysis age ≥5 years (OR=6.287, 95% CI: 2.246～17.598, P＜0.001), and lying in bed in most daytime (OR=8.396, 95% CI: 2.348～30.022, P=0.001) were the independent risk factors for constipation in MHD patients (P＜0.05), and plasma albumin was a protective factor for constipation in MHD patients (OR=0.865, 95% CI: 0.788～0.950, P=0.002). The column chart showed that the higher the total score of MHD patients, the higher the risk of constipation. ROC curve showed that the area under the curve (AUC) of the modeling group and the validation group were 0.806 (95% CI: 0.733～0.879) and 0.879 (95% CI: 0.796～0.963) respectively, indicating higher predictive discrimination of the column chart. Hosmer-Lemeshow test and calibration curve indicated that the model had higher prediction consistency.  Conclusion   The risk of constipation in MHD patients is related to primary disease, dialysis age, daily living conditions and plasma albumin level. The nomogram model established based on the four risk factors has good efficacy in predicting the risk of constipation in MHD patients and is helpful for clinical prediction and prevention of constipation. Metrics

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Study on the relationship between serum levels of STING and Sirt3 and vascular calcification in patients with chronic renal failure undergoing maintenance hemodialysis#br# QIAN Shan-shan, ZHANG Xiao-peng, ZHONG Yong-ping, LU Fei 2025, 24 (11):  924-928.  doi: 10.3969/j.issn.1671-4091.2025.11.010 Abstract ( 56 )   Objective  To investigate the relationship between serum levels of stimulator of interferon genes (STING) and silent information regulator 3 (Sirt3) and vascular calcification (VC) in patients with chronic renal failure undergoing maintenance hemodialysis (MHD).  Methods  A total of 157 chronic renal failure patients undergoing MHD treated in Haimen District People's Hospital of Nantong City from January 2021 to May 2024 were assigned as study group, and 157 healthy volunteers for physical examination were recruited as control group. Based on the presence or absence of VC, the study group was further divided into the VC group (n=84) and the non-VC group (n=73). Multivariate logistic regression analysis was used to identify the risk factors for VC in MHD patients. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of serum STING and Sirt3 levels for VC in these patients.  Results  Compared with the control group, MHD patients had significantly higher serum STING level and lower Sirt3 level (t=15.967 and -19.484, P＜0.001). The incidence of VC among the 157 MHD patients was 53.50% (84/157). Compared with the non-VC group, the VC group showed significantly higher STING level and lower Sirt3 level (t=6.935 and -7.717, P＜0.001). Longer dialysis duration (OR=1.052, 95% CI: 1.022～1.083, P=0.001), elevated intact parathyroid hormone (iPTH) level (OR=1.003, 95% CI: 1.001～1.005, P=0.003), and elevated STING level (OR=1.083, 95% CI: 1.042～1.125, P＜0.001) were the independent risk factors for VC, while higher Sirt3 level (OR=0.493, 95% CI: 0.342～0.709, P＜0.001) was the independent protective factor for VC. The area under ROC curve (AUC) for prediction of VC using combined serum STING and Sirt3 levels was 0.871, which was significantly higher than that using STING (0.780) or Sirt3 (0.800) alone (Z=3.327 and 2.947, P=0.001 and 0.003).  Conclusion   Elevated serum STING and decreased Sirt3 are associated with an increased risk of VC in chronic renal failure patients undergoing MHD. Combined measurement of STING and Sirt3 can effectively predict the presence of VC in this patient population. Metrics

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Predictive value of serum chitinase-3-like protein-1 and syndecan 4 levels for prognosis of acute renal failure patients undergoing hemodialysis GAI Yin-ling, DOU Ya-ping, WANG Gang 2025, 24 (11):  930-934.  doi: 10.3969/j.issn.1671-4091.2025.11.011 Abstract ( 32 )   Objective  To investigate the predictive value of serum chitinase-3-like protein-1 (CHI3L1) and syndecan 4 (SDC4) levels for the prognosis of patients with acute renal failure (AKI) undergoing hemodialysis.  Methods  AKI patients who received hemodialysis treatment in Qinhuangdao integrated traditional Chinese and Western medicine hospital of Hebei Port Group Co., Ltd, from January 2019 to August 2021 were selected as the study group. Based on 1-year follow-up results, patients were divided into a survival group and a death group. Additionally, healthy individuals undergoing physical examinations during the same period were selected as the control group. Serum levels of CHI3L1 and SDC4 were measured using enzyme-linked immunosorbent assay (ELISA). Cox regression was used to analyze the factors influencing the prognosis of AKI patients undergoing hemodialysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum CHI3L1 and SDC4 for prognosis of these AKI patients. Survival analysis was performed using the Kaplan-Meier method.   Results   The study group included 150 patients, and the control group included 150 individuals. The serum levels of CHI3L1 [(82.33±10.19) vs. (51.85±8.34) ng/L] and SDC4 [(6.89±1.65) vs. (3.40±1.05) ng/L] in the study group were higher than those in the control group (t=28.350, 21.855, P＜0.001). The creatinine (t=3.722, P＜0.001), uric acid (t=3.627, P＜0.001), tumor necrosis factor-α (TNF-α) (t=3.557, P=0.001), CHI3L1 (t=6.299, P＜0.001), and SDC4 (t=7.277, P＜0.001) in the death group were higher than those in the survival group (P＜0.05). COX regression analysis showed that serum creatinine (HR=4.625, 95% CI:2.027～10.555, P＜0.001), uric acid (HR=4.334, 95% CI:2.038～9.217, P＜0.001), TNF-α (HR=3.160, 95% CI:1.642～6.081, P＜0.001), CHI3L1 (HR=5.227, 95% CI:1.950～14.009, P=0.001), and SDC4 (HR=4.816, 95% CI:1.947～11.911, P＜0.001) were all factors affecting the prognosis of AKI patients undergoing hemodialysis . ROC curves revealed that the  area under the curve (AUC) of CHI3L1, SDC4, and their combination in predicting poor prognosis in AKI patients undergoing hemodialysis was 0.770 (95% CI: 0.694～0.835), 0.766 (95% CI: 0.690～0.831), and 0.870 (95% CI: 0.806～0.920), respectively.  The AUC for the combination was greater than that for CHI3L1 alone (Z=3.129, P=0.002) and for SDC4 alone (Z=2.600, P=0.009). Kaplan-Meier curves showed that the overall survival rate of the high CHI3L1 group was lower than that of the low CHI3L1 group (Log-rank χ²=62.729, P＜0.001); the overall survival rate of the high SDC4 group was lower than that of the low SDC4 group (Log-rank χ²=52.709, P＜0.001).  Conclusion  Serum levels of CHI3L1 and SDC4 are elevated in AKI patients and are factors influencing the prognosis of AKI patients undergoing hemodialysis. The combined detection of CHI3L1 and SDC4 has high predictive value for poor prognosis in these patients. Metrics

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Research progress of prediction models for all-cause mortality in hemodialysis and peritoneal dialysis patients ZHU Wen-bo, CUI Jin-zhao, XIONG Yu-xiang, ZHANG Shuo, ZHOU Yue, QIN Yan, XIA Jing-hua 2025, 24 (11):  935-937.  doi: 10.3969/j.issn.1671-4091.2025.11.012 Abstract ( 83 )   All-cause mortality in hemodialysis and peritoneal dialysis patients exhibits modality-specific biological mechanisms, while current risk prediction models face challenges in cross-modality validation and temporal treatment parameter integration. Developing machine learning frameworks that dynamically incorporate multidimensional clinical data and dialysis-specific variables could overcome limitations in traditional model construction, ultimately supporting precision decision-making for end-stage renal disease management. Metrics

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Recent progresses in impact of dialysis blood flow rate on prognosis in hemodialysis patients ZHANG Yue-ming ZHANG Zhou-cang 2025, 24 (11):  938-941.  doi: 10.3969/j.issn.1671-4091.2025.11.013 Abstract ( 73 )   Increasing the dialysis blood flow rate enhances the blood volume through dialyzer and thereby improves solute clearance, which is a critical factor in ensuring adequate hemodialysis. Adequate dialysis is essential for reducing morbidity and mortality in maintenance hemodialysis (MHD) patients. However, data from Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate significant international variations in dialysis blood flow rate. Due to the differences in dialysis practice across countries, establishing an optimal dialysis blood flow rate for MHD patients remains controversial. This review examines the current status of dialysis blood flow rate, their relationship with clinical outcomes in MHD patients, and the underlying mechanisms. Metrics

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Hemodiafiltration: Cardioprotective hemodialysis DU Hui, ZUO Li 2025, 24 (11):  942-945.  doi: 10.3969/j.issn.1671-4091.2025.11.014 Abstract ( 99 )   Hemodiafiltration (HDF) is a dialysis technique that combines the principles of diffusion and convection. Cardiovascular disease is the leading cause of death among dialysis patients, accounting for approximately 32% to 55.9% of all-cause mortality. Studies have shown that HDF can significantly reduce the risk of cardiovascular death. The potential mechanisms include enhancing hemodynamic stability, effectively removing uremic toxins, correcting electrolyte disturbances, and alleviating inflammation and oxidative stress. In addition, HDF may also effectively ameliorate anemia and improve malnutrition, thereby further reducing the risk of cardiovascular events. This article reviews the research evidence and potential mechanisms of HDF in cardiovascular protection. Metrics

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High volume hemodiafiltration: Ensuring water and dialysis fluid quality for optimal patient care Rui Lucena, Bernard Canaud 2025, 24 (11):  946-950.  doi: 10.3969/j.issn.1671-4091.2025.11.015 Abstract ( 155 )   Dialysis fluid is the final product of a multi-step precision manufacturing process, with its quality directly impacting treatment efficacy and patient safety. Strict standards for dialysis water and ultrapure dialysis fluids have been established as essential prerequisites for online convective therapies, such as high-volume hemodiafiltration (HDF). These standards enhance the biocompatibility of the dialysis system, reduce systemic inflammation in dialysis patients, improve the response to erythropoiesis-stimulating agents, and ultimately have the potential to improve patient survival. This review provides a comprehensive update on the quality management requirements for water and dialysis fluids, with a specific focus on their role in optimizing high-volume hemodiafiltration. Metrics

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The predictive value of serum MMP-2 and VCAM-1 for autogenous arteriovenous fistula failure in maintenance hemodialysis patients ZHANG Ming-hui, WAN Guo-ping, LUAN Sen 2025, 24 (11):  951-955.  doi: 10.3969/j.issn.1671-4091.2025.11.016 Abstract ( 31 )   Objective To investigate the predictive value of serum matrix metalloproteinase-2 (MMP-2) and vascular cell adhesion molecule-1 (VCAM-1) for autogenous arteriovenous fistula (AVF) failure in maintenance hemodialysis (MHD) patients.  Methods   A total of 197 uremic patients undergoing MHD in this hospital from March 2021 to June 2024 were selected as the research subjects. According to the diagnostic criteria for AVF failure, the patients were assigned into an AVF normal group (116 cases) and an AVF failure group (81 cases). Enzyme linked immunosorbent assay (ELISA) kits were used to detect serum MMP-2 and VCAM-1. Laboratory indicators including blood calcium and phosphorus, hemoglobin, and platelet were routinely detected. Spearman correlation analysis was used for correlation analysis. Multivariate logistic regression model was applied to analyze the influencing factors for AVF failure in MHD patients. Receiver operating characteristic (ROC) was applied to analyze the predictive value of serum MMP-2 and VCAM-1 for AVF failure in MHD patients.  Results  In AVF failure group, intradialytic hypotension (χ2=9.167, P=0.002), AVF stenosis (χ2=19.391, P＜0.001), hyper-coagulation predisposition (χ2=43.585, P＜0.001), low platelet (χ2=20.494, P＜0.001), compression time ≥30 min on puncture site (χ2=26.204, P＜0.001), serum MMP-2 (t=7.640, P＜0.001) and serum VCAM-1 (t=7.801, P＜0.001) were higher than those in AVF normal group. AVF stenosis, hyper-coagulation predisposition, and compression time on puncture site were positively correlated with serum MMP-2 (r/rs=0.510, 0.443 and 0.431 respectively; P＜0.001) and serum VCAM-1 (r/rs=0.519, 0.436 and 0.455 respectively; P＜0.001), while blood pressure and platelet were negatively correlated with serum MMP-2 (r=-0.462 and -0.605; P＜0.001) and serum VCAM-1 (r=-0.465 and -0.623; P＜0.001) levels. Intradialytic hypotension (OR=2.964, 95% CI: 1.516～5.794, P=0.001), low platelet (OR=2.974, 95% CI: 1.463～6.046, P=0.003), hyper-coagulation predisposition (OR=2.879, 95% CI: 1.405～5.899, P=0.004), compression time ≥30 minutes on puncture site (OR=3.246, 95% CI: 1.737～6.066, P＜0.001), serum MMP-2 (OR=3.447, 95% CI: 1.830～6.492, P＜0.001) and serum VCAM-1 (OR=3.426, 95% CI: 1.971～5.954, P＜0.001) were the risk factors for AVF failure in MHD patients. The area under the curves (AUC) of serum MMP-2 and serum VCAM-1 for predicting AVF failure were 0.789 and 0.785 respectively; the AUC of combined serum MMP-2 and VCAM-1 for the prediction was 0.889, which was superior to the prediction ability using serum MMP-2 (Z=3.323, P=0.001) or serum VCAM-1 (Z=3.486, P=0.001) alone.  Conclusion  MMP-2 and VCAM-1 are positively correlated with AVF stenosis, hyper-coagulation predisposition, and longer compression time on puncture site, and negatively correlated with blood pressure and platelet level. Serum MMP-2 and VCAM-1 can predict AVF failure in MHD patients, and combination of the two serum levels obtains better prediction ability. Metrics

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Brachiobasilic fistula vs. upper arm arteriovenous graft for dialysis access: a systematic review and meta-analysis LI Dan DU Zong-hua DAI Feng-ming LONG Qing WANG Wei 2025, 24 (11):  956-963.  doi: 10.3969/j.issn.1671-4091.2025.11.017 Abstract ( 46 )   Objective  To compare the patency rates and complications of brachiobasilic arteriovenous fistula (BBAVF) and upper extremity arteriovenous graft (AVG) as vascular access options, providing evidence to optimize tertiary vascular access selection.  Methods  We searched PubMed, the Cochrane Library, Embase, and ScienceDirect databases and manually screened the references. The Newcastle-Ottawa Scale was used to assess study quality. Data were extracted and a meta-analysis was performed to compare the one- and two-year patency rates and complication rates between BBAVF and AVG.  Results  A total of 24 studies were included. The BBAVF group demonstrated superior outcomes compared to the AVG group in terms of one-year primary (OR=1.837, 95% CI: 1.332～2.533, P＜0.001), assisted (OR=2.242, 95% CI: 1.439～3.494, P＜0.001), secondary (OR=1.465, 95% CI: 1.029～2.088, P=0.034), and cumulative patency rates (OR=1.739, 95% CI: 1.052～2.875, P=0.031). The BBAVF group also had better two-year primary (OR=2.140, 95% CI: 1.469～3.118, P＜0.001), assisted (OR=2.529, 95% CI: 1.789～3.575, P＜0.001), secondary (OR=1.748, 95% CI: 1.371～2.229, P＜0.001), and cumulative patency rates (OR=2.002, 95% CI: 1.234～3.249, P=0.005). Regarding complications, the AVG group had a higher risk of postoperative infection (OR=0.207,  95% CI: 0.128～0.334, P＜0.001), thrombosis (OR=0.285, 95% CI: 0.207～0.392, P＜0.001), and steal syndrome (OR=0.628, 95% CI: 0.396～0.996, P=0.048), while the BBAVF group had a higher risk of bleeding (OR=2.725, 95% CI: 1.549～4.793, P=0.001). There were no significant differences between the two groups in the incidence of aneurysm (OR=0.849, 95% CI: 0.457～1.577, P=0.605), anastomotic stenosis (OR=0.471, 95% CI: 0.133～1.666, P=0.243), or overall complications (OR=0.924, 95% CI: 0.502～1.701, P=0.799).  Conclusion  BBAVF is superior in terms of patency rate and control of infection and thrombosis, and is recommended as the first choice for patients with good vascular conditions. AVG is more suitable for urgent dialysis or for patients with poor vascular conditions. Metrics

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Effects of core stabilization training on exercise capacity, dialysis adequacy and quality of life in maintenance hemodialysis patients ZOU Li-hua, TENG Yan-juan, CHEN Ting-fang, SHAO Jun-jie, YANG Li-na 2025, 24 (11):  964-968.  doi: 10.3969/j.issn.1671-4091.2025.11.018 Abstract ( 64 )   Objective   To explore the effects of core stabilization training on exercise ability, dialysis adequacy, fatigue symptoms and quality of life in patients with maintenance hemodialysis (MHD).   Methods  Sixty patients undergoing MHD in the Hemodialysis Center of The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2023 to May 2024 were selected as the study objects. They were divided into the experimental group (29 cases) and the control group (31 cases) by random number table method. The control group received conventional treatment and nursing, and the experimental group received core stabilization training on the basis of conventional treatment and nursing. The differences of urea clearance index (Kt/V ), urea reduction rate (URR), 30 second sit to stand test (30s STS), 6-minute walk test (6MWT), fatigue scale-14 (FS-14) scores, and the 36 item short form health survey (SF-36) scores were compared between the two groups before and after the intervention.  Results   After core stability training, the scores of Kt/V, URR, 6MWT, 30s-STS, FS-14, and SF-36 in the experimental group were significantly different from the baseline levels (t =- 6.558, 5.289, -14.028, -25.713, -3.251 and -12.371 respectively; all P＜0.001) and significantly different from those in the control group (t =7.271, 2.758, 7.072, 11.905, -5.647 and 3.276 respectively; P＜0.001, 0.021, ＜ 0.001, ＜ 0.001, ＜ 0.001 and 0.002 respectively).  Conclusions   Core stabilization training during dialysis can improve dialysis adequacy, enhance exercise ability, reduce fatigue symptoms, and improve quality of life in MHD patients. Metrics